Background Data: Spondylodiscitis is a major clinical condition with significant health and economic burden. There is a controversy regarding the use of conservative therapy with systemic antibiotics alone versus combined with surgery to manage primary spondylodiscitis. Study Design: Retrospective clinical case study. Purpose: To assess the clinical outcome of treatment of the patients with primary spondylodiscitis. Patients and Methods: This study was conducted on 27 patients with primary spondylodiscitis. There were 17 males and 10 females. The mean age was 49.96 ± 9.83 years. All the patients presented with local pain over the involved vertebral level. The clinical outcomes were assessed using the Visual Analogue Scale (VAS), ASIA score, and Kirkaldy-Willis functional outcome criteria. Results: Eight patients (29.6%) were managed by medical treatment alone. Nineteen patients (70.4%) were managed surgically, including seven patients who were operated on by laminectomy and 12 patients by posterior decompression and fusion, followed by subsequent treatment with antibiotics. VAS score was reduced significantly in the patients treated surgically compared with the patients treated medically at 1 and 3 months (P value < 0.001 and = 0.010, respectively) but not at 6 and 12 months of the follow-up period (P value = 0.235 and 0.886, respectively). There was no significant difference between the two groups regarding CRP and ESR reduction levels, the functional outcome, and the complications at different time intervals. Conclusion: Posterior decompression with or without fusion was more effective than medical treatment in reducing the pain in patients with primary spondylodiscitis at 1 and 3 months of the follow-up period without influencing the final clinical outcome. (2021ESJ230)